Toward an expanded and updated conceptualization of termination: Implications for short-term, individual psychotherapy.

Abstract

This article examines a loss metaphor that has been used to conceptualize clients' experience of termination for over 40 years. Review of contemporary theoretical and empirical research in clinical and developmental psychology implicates directions for revising, expanding, and modernizing this approach to termination for short-term psychotherapy. Specifically, the predictions that termination is inherently a crisis for clients and therapists were not confirmed in extant research. However, other aspects of the termination-as-loss model could be updated to be consistent with current theory and research. Several recommendations for a more contemporary approach to termination were made. In particular, a termination-as-transformation metaphor seems to incorporate current theory and research as well as critical aspects of the traditional approach to termination.Theoretical and empirical research on termination has accumulated very slowly, and much of the research is shrouded in debate and controversy. At the heart of the controversy over termination is the termination-as-loss model, which is the expectation that clients experience the end of psychotherapy as a significant loss. It is noteworthy that this model has been recently adopted in theories of short-term and time-limited psychotherapy (e.g., Bauer & Kobos, 1987;Mann, 1973;Strupp & Binder, 1984). Although versions of the termination-as-loss model have been around for over four decades (e.g., Balint, 1950), there has not been a significant attempt to update and overhaul critical components of this model in light of contemporary research and theory. There are indications, however, that there are problematic aspects of this model. This has led some authors to disregard this approach to termination and some to suggest that termination is a trivial aspect of therapy (Budman & Gurman, 1988;Hill, Carter, & O'Farrell, 1983). In the absence of either a contemporary revision of the termination-asloss model or an alternative conceptualization of termination, authors have turned to pragmatic, somewhat atheoretical, approaches to termination (e.g., Budman & Gurman, 1988;Pinkerton & Rockwell, 1990). Therefore, the purpose of this article is to examine the termination-as-loss model in order to discard aspects of this model that are particularly problematic and to update and expand more valuable aspects of this model to STEPHEN M. QUINTANA received his PhD from the University of Notre Dame in 1989. He is currently an Assistant Professor in the Counseling Psychology Program at the University of Texas at Austin. He teaches a course on short-term psychotherapy and conducts research on processes in short-term psychotherapy, ego development in adolescence, and development of Mexican-American children.

Therapists’ Responses to Treatment Termination: An Inquiry into the Variables that Contribute to Therapists’ Experiences

“…This view applies more often to clients, but has also been applied to therapists, whose responses to termination, positive as well as negative, have been analyzed as features of the mourning process (Martin & Schurtman, 1985;Quintana, 1993;Ward, 1984).…”

“…Therapists who experience emotional difficulty in treatment termination are more likely to have difficulty terminating the treatment in a way that meets their clients' therapeutic needs (Quintana, 1993;Siebold, 1991). They may avoid dealing with their own, and their clients' feelings at termination, (Anthony & Pagano, 1998), may not leave enough time for summary and evaluation (Germain & Gitterman, 1996).…”

Relações entre intervenções terapêuticas, motivação para mudança e eficácia adaptativa em psicoterapia breve

“…Estes achados corroboram as perspectivas teóricas de que qualquer psicoterapia só pode ser considerada acabada após o rebaixamento das ansiedades levantadas por esta última etapa do processo, uma vez que este pode ser considerado um momento de crise, transformadora, para a condição do paciente (Enéas e Rocha, 2011;Quintana, 1993;Knox et al, 2011).…”

Time and again: Intermittent Brief Dynamic Therapy

“…The internalization of the therapist as a good internal object is considered to hinge upon the extent to which the termination phase is successfully worked through and the loss of the therapist mourned. This position has however been challenged by other Brief Dynamic Therapists such as Quintana (1993) who argues that therapists need to acknowledge review and support clients' sense of accomplishment in therapy and the steps they have taken towards health independence and maturity. It is this stance that will lead to internalisation .…”